ABSTRACT

Objectives:

The purpose of this study is to discuss the superiority of the approaches to each other by means of timing, and necessity of surgery in facial paralysis related with temporal bone fractures in the view of literature.

Materials and Methods:

Twenty-seven cases, who had an operation due to facial paralysis caused by temporal bone fractures, were reviewed retrospectively. Transmastoid approach was applied in 14 (52%) of these cases, transtemporal supralabyrinthine approach was applied in 10 (37%) cases and translabyrinthine was applied in 3 (11%) cases. The operation indication was determined with clinical examination, radiologic findings and electrodiagnostic tests.

Results:

There was interruption in the nerve in 9 (33.3%) of cases, bone fragments impinging on the nerve in 8 (29.6%) of cases and perineural hematoma in 10 (37%) of cases. Edema was found in the nerve of all the cases who had an operation within a month after the trauma. The site of the injury in all transverse fractures was in the labyrinthine segment. In longitudinal fractures neural injury in 90.4% of cases was situated in the perigeniculate region.

Conclusion:

The results were better in early operated cases and in the transtemporal supralabyrinthine approach.

ÖZET

Amaç:

Temporal kemik fraktürlerine bağlı fasiyal paralizilerde cerrahinin gerekliliği, zamanlaması ve yaklaşım şekillerinin birbirine üstünlüklerinin literatür eşliğinde tartışılması.

Gereç ve Yöntem:

Temporal kemik fraktürüne bağlı fasiyal pa-ralizi nedeniyle ameliyat edilen 27 olgu retrospektif olarak incelendi. Bunların 14'üne (%52) transmastoid, 10'una (%37) transtemporal supralabirentin (orta kafa çukuru), 3'üne (%11) translabirentin yaklaşım yapıldı. Ameliyat endikasyonu, klinik muayene, radyolojik bulgular ve elektrodiagnostik testler ile konuldu.

Bulgular:

Olguların 9'unda (%33) sinirde kesi, 8'inde (%29.6) kemik fragmanların basısı, 10'unda (%37) perinöral hematom mevcuttu. Travmadan sonra 1 ay içinde ameliyat edilen 21 vakanın hepsinde sinir ödematöz görünümde idi. Lezyon yeri transvers fraktürlerin hepsinde labirentin segment, longitüdinal fraktürlerde ise, %90.4 perigenikülat bölge olarak tespit edildi.

Sonuç:

Erken cerrahi yapılan olgularda ve transtemporal supralabirentin (orta kafa çukuru) yaklaşımlarda sonuçlar daha iyi bulunmuştur.